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HIV diagnoses fall in San Francisco but disparities persist; Getting to 0 plans target PrEP, rapid ART and re-engagement
Summary
The 2015 HIV epidemiology report shows new diagnoses fell to 255 and viral-suppression metrics improved, but African Americans and homeless people lag on key outcomes; the Getting to 0 consortium plans targeted PrEP uptake, rapid ART initiation, linkage/retention efforts and anti-stigma work, backed by recent city investments.
San Francisco's 2015 HIV epidemiology report shows encouraging overall declines in new diagnoses and improvements in the care continuum, but persistent disparities mean the city's "Getting to 0" effort must target specific populations to close the gaps.
Susan Shearer, director of the HIV Epidemiology Section, presented highlights from the annual report, noting a drop from 453 new diagnoses in 2012 to 255 in 2015 and an increase in the number of people living with HIV to nearly 15,000. "We have almost 15,000 people living with HIV in the city," Shearer said, emphasizing both population-level progress and pockets of continued need.
The report shows improvements across the care cascade: faster linkage to care, shortened time from treatment initiation to viral suppression, and rising viral-suppression rates among newly diagnosed patients. Median days from diagnosis to care have fallen (diagnosis-to-care median ~7 days), and diagnosis-to-viral-suppression median fell from 147 to 88 days in the reviewed period.
Yet disparities remain. African American men had the highest rate of infection among men in 2015 (about 140 per 100,000), compared with 83 per 100,000 for Latino men and 52 per 100,000 for white men. Viral suppression is substantially lower among homeless people (33 percent virally suppressed in the report snapshot) and lower for African Americans and younger age groups.
Dr. Hyman Scott, medical director of clinical research and clinician at Ward 86 at San Francisco General Hospital, outlined Getting to 0 priorities: citywide PrEP (pre-exposure prophylaxis) scale-up focused on MSM of color, young MSM and trans women; rapid antiretroviral therapy (RAPID) initiation and treatment hubs to begin therapy within hours to days after diagnosis; data-driven linkage, retention and re-engagement programs; and stigma-reduction initiatives. He cited coordinated clinical and community efforts and said the mayor and supervisors recently provided $3.1 million in new funding (on top of $1.2 million the prior year) as part of city investments supporting Getting to 0 efforts.
Commissioners asked detailed questions about data sources, counting of deaths, whether incarcerated populations are included, and the performance measures that will guide targeted programs. Shearer explained surveillance methods, the use of state and national death registries for cause-of-death ascertainment, and the department's additional analyses to distinguish HIV-related from non-HIV-related deaths.
The commission asked staff to continue providing updates (including a regular December update tied to International AIDS Day) and to drill down on metrics for priority populations so programs can be evaluated and refined.
